Provider Demographics
NPI:1649972431
Name:LYNCH, SAMUEL ADRIAN (FNP-C, ARNP)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ADRIAN
Last Name:LYNCH
Suffix:
Gender:M
Credentials:FNP-C, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 E FRAKTUR RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-3613
Mailing Address - Country:US
Mailing Address - Phone:641-220-0343
Mailing Address - Fax:
Practice Address - Street 1:26224 N TATUM BLVD STE 15A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-7500
Practice Address - Country:US
Practice Address - Phone:480-663-9632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ289215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily